CONFERENCE STUDENT/INDIGENOUS REGISTRATION FORM
Fax to: (214) 341-9522 (with Credit Card info and copy of valid Student ID (if student) or Mail with Check and copy of valid Student ID to: IHI, Conference Registration 10875 Plano Rd., Suite 123, Dallas, TX 75238 To register by phone, call: (804) 247-1655 See Conference Information at www.intestinalhealth.org/Taosevent
This form is for Conference STUDENT & INDIGENOUS Registration To register with the special Student or Indigenous discount, you must send in a copy of your valid student ID (if student) and bring it to the conference to present at registration. Student registration DOES NOT include evening events (Thurs. reception and Sat. Banquet). It DOES include conference daytime Snacks and Lunch. Please check one of the following: Full Conference Program and Meals ............... _______ Friday Only Program and Meals ...................... _______ Saturday Only Program and Meals ................... _______ Sunday Only Program and Meals .................... _______ Additional Welcome Reception Ticket(s) .......... _______ Additional Banquet Ticket(s) ............................ _______ Special Student & Indigenous Discount Conference Fees Full Conference Program & Daytime Meals (April 3 - 6, 2008) Friday only Program & Daytime Meals (April 4, 2008) Saturday only Program & Daytime Meals (April 5, 2008) Sunday only Program & Daytime Meals (April 6, 2008)
$125 $50 $50 $25
Additional Ticket Fees Thursday, April 4, 2008 Welcome Reception - $45.00 Saturday, April 6, 2008 Banquet - $60.00
First Name: Address: City: State:
Last Name:
Zip Code:
Phone:
Email Address (required for confirmation): Note: By providing your e-mail, you grant IHI permission to contact you via e-mail regarding your registration and updates on the "The Higher Truth of Health" Conference. Name of person who contacted me: Method of payment: ___Master Card ___Visa ____Check or money order enclosed (Please make payable to: Intestinal Health Institute in U.S. dollars drawn on U.S. bank.) Credit Card Number: Name On Card: Signature: Total Amount Due: $ PLEASE NOTE: Registration will not be processed without payment or if submitted with declined or invalid credit cards. COURTESY NOTE: “The Higher Truth of Health” is a non-smoking conference. Also, out of respect for our chemically sensitive patrons, we ask that no perfume, cologne, hair spray or other perfumed products be worn at the conference. Thank you.
Exp Date:
3 Digit SSV Code: Billing Zip Code: Date:
REFUND POLICY: Refunds (less a $50.00 processing fee) will be given to registrants who cancel by 5:00 p.m. on Friday, March 14, 2008. No refunds will be made after that time. DISABILITY ARRANGEMENTS: If special arrangements are required for anyone with a disability, please contact us at (804) 247-1655. NOTE: You may transfer your registration to another person at any time.